BONUS: Making Technology Work for Rapidly Changing Public Health Needs

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode: technology that makes disease investigation easier; and the need for a unified system serving public health teams on the front lines. We talk with Jim Ivey, COO and co-founder of Chexout, next.

Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today: how the fight against infectious diseases benefits when information systems work together; and the promise of one solution helping public health departments streamline operations.

On this bonus episode of the show, we visit with Jim Ivey, COO and co-founder of Chexout, an information technology and services firm based in Vienna, Virginia. In this conversation, he tells us how the right technology can help pull teams together, make them more efficient, and allow them to better share information vital to urgent disease investigations.

We start with Ivey's thoughts about the impact a pandemic has had on public health and whether he thinks COVID-19 has changed the operating landscape.

JIM IVEY:
I do believe it has because we've had so many of our DIS and, you know, anybody who was in a public health department being redeployed to COVID and having to use a new tool set and having to deal with scales that we'd never seen before.

And I really believe that having to work with COVID, we learned a lot of lessons—specifically that you need the right technology tools in order to be able to manage outbreaks and to do things like manage large numbers of staff.

For instance, one of our clients, West Virginia, has 1000 contact tracers. That includes, you know, DIS, National Guard, college volunteers, and, you know, newly hired people. So, trying to bring all those different groupings of people together to do a specific task, you know, the need to be done a very specific way.

When they're also—some are working in the office, and some are working from home, so it's very important that you have a good platform to manage your workforce and to also help them complete tasks. So, that was one of the things that we really learned.

JOHNSON:
When it comes to planning for pandemic, I think it goes without saying that no matter how well you're doing, you're going to find yourself with a lot of needs.

Is that what you witnessed as you were working with your clients, helping them get through this tough situation?

IVEY:
Yes. Actually, that's a really good description of exactly what we experience with our clients.

And that was another lesson that we learned is, you know, you can have your software platform with all the best tools, all coming together, interoperable, but you need to be extremely flexible so that you can, you know, meet the requirement of today, of tomorrow, of six months later. And during COVID, we didn't have normal development windows. So, we had to do things in a very compressed timeframe.

Philadelphia, one of our customers, a very good example of having to fill those different needs that keep popping up because they were using our software for their STD program for notifications. And then, with COVID, they called and asked if they could use our software to run their mobile COVID testing bands, which we quickly, you know, modified and deployed.

And then with immunizations, we got a call to do notifications using data from their vaccination software, you know, putting the reminders. And then, most recently, we got a call to help them with using our software to run their mobile vaccination vans.

So, you never know what the next request is going to be, and clients need to know that they can depend on their software vendor to be able to move as fast as, you know, needs evolve.

JOHNSON:
People absolutely know a lot more about public health now than they did last January. They know more about how vaccines are developed and tested—maybe they even know too much—but the point is awareness is at an all-time high.

How do you think that's going to affect the ability of public health departments when they are trying to modernize? When they're trying to roll out new technology? When they're trying to do a better job with new tools that are available, like yours and others?

IVEY:
Well, I think one of the benefits of the new visibility of what public health has been doing forever—you know, contact tracing and disease investigations—is, one, the benefit of this new Build Back Better funding—this $1.13 billion for DIS and for technology solutions to help DIS to do their jobs—that's been a great benefit of the greater visibility.

And then, I think that, you know, having the marketplace where everybody had tried to come together and find great solutions to deal with the problems educated a lot with us in the industry on what needs to be done better and how you can better bring together solutions.

So, I think there's been a lot of benefits to the greater visibility.

JOHNSON:
Contact tracing is one of those phrases that people have learned about and many of them are a little nervous about it. I imagine, though, you've been working to try and help departments get through that problem, that challenge, that opportunity, for a long time, long before the pandemic got here.

IVEY:
That's correct.

We were one of the few companies that had live deployable contact tracing software available when COVID first hit because we've been working with, you know, public health and with disease investigation specialists, specifically tracking down or helping to get a patient in care if they've, you know, contracted HIV, or syphilis, or gonorrhea, chlamydia.

So, we were able to take those same tools and configure them for COVID investigations.

JOHNSON:
How does the software work? Can you give us an English version of how Chexout goes about doing this contact tracing and surveillance investigative work for health departments?

IVEY:
Sure.

Well, the number one thing is to try to keep it really simple.

So, the first step of the process is we're data-agnostic so that we can work in any health department's ecosystem. They may have an electronic health record or an electronic disease surveillance system or a laboratory system that we need to take data from in order to initiate an investigation.

Upon getting that information, we can then auto-assign investigations out. In the case of a large state or city, they may have work groups where one group of contact tracers focuses on adolescents and another group focuses on long-term care facilities. The software can take the patient demographics and then automatically assign investigations to the appropriate contact tracer.

From there, the software can automatically notify the patient that they're going to be contacted by a contact tracer, and we found that sending that automatic notification can increase the probability that patient is going to answer the phone when you call instead of just ignoring it by about 90%. So, building in some of those automated tools really help, you know, move the process along.

The next step of the process then is actually interviewing the patient, collecting the information, and then getting their contacts so that we can then reach out to them and get them into care as well and get them into the testing. And that's where tools like having cluster diagrams so that you can see a visualization of your entire investigation—who's been tested and how many people were connected to each other—becomes very important.

And with COVID, it was extremely important that we collect a lot of information about where people were self-reporting places they've been, because we wanted to know if a gym, or a restaurant, or a large event, or a small event was a place where a lot of people came in contact with each other that tested positive for COVID.

So, the software has an outbreak management component to it that will track all of that information, aggregate it, and then alert a contact tracer or a disease intervention specialist when the software has identified a place that has had so many people test positive over a certain period of time so that they can then, you know, deploy resources more effectively.

It's all about trying to bring together as many tools as possible, and then automate a lot of the functions so that we can keep our contact tracers and DIS focused on interacting with the patients and not doing things like trying to do calculations and aggregate information.

JOHNSON:
Talk a little bit more about this ability to predict outbreaks. You sent some notes along that said you're able to do that, too.

IVEY:
Sure, yeah, that's a core piece of our software now, and it seems to be one of the things that's helping our health departments the most.

When a DIS is working an investigation—especially in COVID—with large numbers, there's no way for, you know, a single person or a group of people to know at any given time how many people have named a certain place down to maybe the hour that they were there.

And the software has built into it the ability to track all this information and let you know when it identifies, you know, community-based or communal-based clusters. And it can then, you know, alert you and then allows for the DIS to make a decision on whether or not they want to follow up on that outbreak.

So, it's a great tool for just bringing together all this information.

JOHNSON:
Contact tracing, as I mentioned earlier, does scare a lot of people. They are worried about the government getting too much information about where they are, what they've been doing, what they might be doing.

But in a case of an outbreak like this, it can actually make the difference between an economy staying open and closing down. Isn't that right?

IVEY:
That's right.

One of the things that we did with West Virginia was, you know, early in the outbreak, when schools were still open, they had a school dashboard. And, you know, our timely data every day on number of infections would be the difference between a school being open or a school being closed, or football being played, or sports being played, or no sports played.

So, that the information is very important.

JOHNSON:
Many people are sports fans. All of the major professional leagues have used some sort of contact tracing to keep their teams on the fields and in the arenas.

You were involved in some of that work, as well.

IVEY:
We were.

We were contacted by Indianapolis, and they were getting ready for the NCAA tournament. They actually called us a little bit late; they gave us 23 days to have the software up and running and customized and ready for the tournament—and we met that deadline.

JOHNSON:
So, what protections do you build into your programs that help public jurisdictions address those security and privacy concerns?

IVEY:
Well, security is paramount in anything with healthcare, especially when you're working with public health agencies, you know, there's an actual impetus on that because the public has to trust, right? So, you know, the security is first and foremost.

And, secondly, on that: you know, there's no, like, iPhone app tracking you. There's nothing where, you know, something's being collected about you that you're not giving to the public health department. It's all information that you volunteered to them. So, a lot of this information that we use for figuring out if a place has an outbreak, or, you know, people that are connected to each other—it's all volunteered by the patients.

So, it's very helpful when they engage in the process. And, like you said earlier, the more that the patients in the community engaged in the process of contact tracing, the easier it is to keep the outbreaks down and to keep businesses open.

JOHNSON:
Pulling from your experience—not just during the pandemic, but before that—what would your advice to a jurisdiction be if it was considering this sort of a program? What does it need to keep in mind to be successful?

IVEY:
I think the most important thing is that public health departments need to find multifunctional, unified software systems that can easily integrate with other software systems they work with—you know, they're inter-operable.

Beyond that, we know that—especially with COVID—every day, things were changing. So, you have to have the flexibility to also be able to customize pieces of the platform to meet new and emerging needs. So, I think that's really the best thing, is to find the right software vendor that brings all of the pieces together for you in one place.

JOHNSON:
Finally, considering what we've learned from the pandemic—what you've learned from the pandemic—is there any way, in your mind, to manage an outbreak without a robust contact tracing program in place?

IVEY:
No. No, I really don't see that there is a way to.

If you don't have contact tracing, you can't know who to test, and follow up with, and try to get into treatment. So, no, I don't think that's possible at all.

JOHNSON:
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This show is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be well.